Yarmulkas (kipot) for the participants; yarmulka (kipah) for the baby
(optional)

If the bris is taking place in a synagogue, country club or restaurant,
a cocktail table, two chairs and a wastebasket are needed for the bris set
up. Or, if the bris is taking place in the home, a bridge table will do (along
with two chairs and a wastebasket). I can also set up my things on one of
the corners of the dining room table or when I arrive, we'll figure out the
best place to set up.

Instructions:

The Hebrew/Jewish (Yiddish, Ladino, etc.) names of the father, mother
and baby are needed for the ceremony. Also, is the father or mother of the
baby descended paternally from a Kohen or Levi? (A naming ceremony is part
of the Brit Milah ceremony.)

Please do not feed the baby about one hour before the brit milah. The
baby can be fed right after the ceremony.

To reduce the baby's discomfort, he may suck on a gauze pad dipped in
wine before (if needed) and after the Brit Milah ceremony.

A Brit Milah takes place on the eighth day during the daylight hours only.
The day of birth counts as day one. Please confirm the date, time and location
of the Brit Milah with the mohel before informing your guests. Also, please
make sure no one else in the family is making arrangements with another mohel.

A Brit Milah can be postponed at any time (including the day of the ceremony)
if there is any question about the health of the baby. Normal physiological
jaundice is normal and does not delay the Brit Milah.

Dress the baby simply for the ceremony. A gown, stretchy or kimono is
fine; please avoid outfits with many small buttons or the "zipper from the
neck to the foot" outfit. Instead of a t-shirt underneath, use a onesie.

A minyan (quorum of ten) is preferred, but not required. The appointing
of Godparents is not a Jewish tradition. We do not have godparents for boys
or for girls. In Judaism, the parents are responsible for the religious upbringing
of the child. It is also a common misnomer to call the Sandak (the one who
holds the baby for the Bris) the godfather. The word Sandak comes from the
Greek word "syndikos" which means patron. Therefore, you may appoint as many
godparents as you wish or none at all. If it will keep peace in the family
by appointing godparents, then do it. Otherwise, skip it. It is up to the
individual discretion of the parents.

It is suggested that kosher food (not kosher-style) be ordered so all
of the guests may partake of the seudat mitsvah (festive meal). The food
is served after the ceremony.

Please, no photography or videotaping is permitted while the baby's diaper
is off or if the Brit Milah occurs on a Shabbat or Jewish holiday.

Post-Bris Care Instructions:

Prepare for a fussy baby. Primary healing time is 24-48 hours.

RISKS, BENEFITS AND ALTERNATIVES:
There are risks, benefits and alternatives to this or any other surgical procedure. They are (bleeding, infection and/or damage to the penis), benefits (spiritual and physical), changes (appearance and sensitivity) and alternatives (not to circumcise). Be aware that cosmetic results will vary from child to child and cannot be guaranteed (i.e. adhesions, scar tissue, curvature, asymmetry, etc.).

There may be some swelling of the area (on one side or both) and you may
notice a thickness on the underside of the penis where the skin was bunched
together. Over time, this will decrease in size.

After each diaper change, apply a sterile gauze pad treated with a healthy
amount of ointment for 3-5 days. If the gauze pad sticks, leave it alone
until it comes off by itself. Put the new gauze pad with ointment on top
of the old one, and after a few diaper changes, both should come off. If
the gauze pad sticks, soak the baby in a shallow tub of warm water to remove
it.

Any bleeding will stain the gauze pad and the diaper. The size and intensity
of the stain will decrease after each diaper change. If bleeding persists,
apply direct pressure with a sterile gauze pad for 15-20 minutes. This should
stop the bleeding. Call the mohel or pediatrician immediately.

If there is a bandage (which is not the same as the gauze pad--the gauze
pad covers the bandaged penis), the nurse or the parents may remove it after
24 hours. If it comes off by itself at anytime - great; if you accidentally
remove it, don't worry. If the bandage unravels, you may re-wrap it. If the
bandage sticks, soak the baby in a shallow tub of warm water to remove it.
After the bandage comes off, continue applying gauze pad and ointment for
a few more days. Your baby should have a wet diaper within a few hours of
the circumcision.

If there is no bandage (not to be confused with the gauze pad), no follow-up
visit is needed. Parents may wish to schedule the first pediatrician's visit
within a week of the circumcision. A follow-up visit by the mohel may be
requested at any time. Most pre- and post-circumcision questions can be addressed by emailing a digital picture or two of the area in question. If the parents do not wish to email a photo, they can make a CD and send it via FedEx or snail mail. If the parents are unwilling to do either, then there will be a $100.00 charge for a separate follow-up in home visit

Following the circumcision, resume the baby's regular routine and treat
him normally.

Sponge bathe the baby until the penis is healed. When the penis is sufficiently
healed (about one week) you may immerse the baby in the bath (assuming the
umbilical cord is healed, as well).

Longer term care:

No further bandaging is necessary. One may continue to apply ointment as needed to enhance further healing. Each child is unique and the techniques of performing circumcisions vary. Cosmetic results will vary from child to child and are not guaranteed (i.e., adhesions, scar tissue, asymmetry, etc.). The circumcision area is not a perfect circle and skin is elastic. There may be some unevenness or asymmetry which will become a non-issue after the baby has healed completely. Even siblings or twins may not look the same even if the Bris was done by the same mohel with the same technique with the same instruments. During the healing process, the head (glans and corona) should remain completely revealed.

Be prepared for a fussy baby. If he’s fussy, it may be for an hour or two. If you'd like, you can blame me any time he cries on the day of and the day after the Bris.

New parents love to micro-analyze the circumcision site. If you have any questions about the healing process or you're not sure what you are seeing, contact me right away - within a week or two of the Bris. DO NOT WAIT! You can call me or e-mail me one or two digital photos. (I don't need an album!) If you call me in three months to tell me there is a problem, there is nothing I can do at that point. It is too late.

There are a number of things you may see during the healing process. They are NORMAL. They include:

The tip will be red or deep red in color. The redness may last for several weeks. During the healing process, the tip may turn blue or bluish/ purple in color. This is normal.

Sometimes a whitish or yellowish waxy-like coating, a yellow crusty-like coating or white spots or dots may occur on the tip or around the circumcision site. This is called granulation. It is normal and part of the healing process. It is not pus or an infection. Pus can be wiped off and will recur; granulation cannot. An infection would mean that the tip is red and swollen and hot to the touch. The baby would most likely have a fever and cry inconsolably. Granulation is more like a scab.

A few weeks into the healing process, a blister may develop along the circumcision line — this, too, is normal. It is often due to friction against the diaper which creates displaced lymphatic fluid (a blister). Apply ointment.

I will often get a phone call from parents 3 - 4 months or 6 - 8 months after the Bris telling me that it has disappeared. For babies who gain weight quickly, the fat of the thighs and abdominal fat pad may cover the circumcision. It retracts inside like the head of a turtle. Gently push the skin back to reveal the head and coronal ridge. Use ointment to avoid adhesions and allow for the free movement of the skin. If it gets stuck in the "in" position, that is called an adhesion. Call me right away. I will suggest several ways to solve the problem. This is very common. If your child continues to gain weight, it may happen again and it may get worse before it gets better. Once we know that the circumcision has healed properly (usually within a week or two of the Bris), it is safe to say that it is a fat problem and not a circumcision problem.

If the gauze pad sticks, DO NOT REMOVE IT! Put the second gauze with ointment on top of the stuck gauze pad. Eventually, both will fall off. Or, you may soak the baby in a shallow tub of warm water for ten to fifteen minutes to remove a stuck gauze pad. It may take two or three soakings.

Once you have stopped using the gauze and ointment, the skin may be dry and separate causing a blood spot on the diaper. Do not worry. It is usually a one time event. Apply ointment.

Please read and follow all instructions. If there is any question about the healing process or appearance of the circumcision, DO NOT WAIT — call or e-mail me immediately.

Some general guidelines:

Once again - please read and follow all instructions.

In the event of an emergency, page me immediately at 1-917-448-2747 and
leave a voice message. For all other non-emergency questions regarding the
Brit Milah ceremony, please call me at 1-212-595-0132.

If a question or emergency arises on Shabbat or a Jewish holiday, you
will not be able to reach me. Please call your pediatrician immediately.
After the Shabbat or holiday has concluded, please call to apprise me of
the situation. If I am unavailable at any other time, and you need assistance,
please call your pediatrician.

I look forward to sharing your simkha. As your son enters the covenant,
so may he enter the world of Torah, the wedding canopy, and a life of good
deeds.

Honors:

The main honors, in order of appearance are:

Kvater and/or Kvaterin - someone to bring the baby into the room where
the ceremony is taking place.

Chair of Elijah - The Chair of Elijah honor may be given to one or two individuals. In addition to the Sandak, this honor should be performed by one who is Jewish. We welcome the spiritual presence of Elijah the Prophet to the Bris ceremony as we welcome Elijah the Prophet to the Passover seder with the Cup of Elijah. According to one interpretation, Elijah the Prophet was rewarded with this seat of honor at all Brisses for during his time he re-established the performance of this mitzvah. This takes place before the Sandak holds the baby for the bris.

Sandek - someone to hold the baby during the circumcision.

Amidah le-berakhot - someone to hold him during the Naming and

Kvater and/or Kvaterin - someone to take the baby out of the room.

Traditionally, it is the parents of the baby who give out the honors at
the bris. Both men and women are included in the ceremony. I recommend that
parents distribute select honors in a meaningful way, rather than pass the
baby around just to include a lot of people.

The honor of bringing the baby into the room at the beginning of the ceremony
and/or taking him out at the end of the ceremony is usually given to the grandmothers
of the baby. Or, the honor may be given to a couple who have been married
for a number of years, who have been trying to have a baby and have not yet
been successful. If this is the first boy for the parents, the paternal grandfather
of the baby holds for the bris and the maternal grandfather of the baby holds
for the Naming portion of the ceremony. (If one grandfather has already served
as a sandak previously, he can defer to the other grandfather.) Placing the
baby on the Chair of Elijah and carrying him from Elijah's chair are honors
that can be given to other relatives. There are many more permutations and
possibilities (older siblings, stepparents, great-grandparents, etc.), so
the best thing to do is prepare a list of those people whom you would like
to include in the ceremony. The mohel can help you decide the best way to
distribute the honors.

Berakhot (Blessings):

Father (after the mohel performs the Brit Milah):

"Barukh Atah Adonai Elohenu melekh ha-olam, asher kideshanu be- mitsvotav
ve-tsivanu le-hakhniso bivrito shel Avraham ovinu.""Blessed are You, Lord our God, king of the universe, who has sanctified
us with His commandments and commanded us to enter him [the baby] into the
covenant of Avraham our forefather."

Mother (on the occasion of coming through childbirth safely):

"Barukh Atah Adonai Elohenu melekh ha-olam, ha- gomel le-hayavim tovot sheh-gemalani
kol tov.""Blessed are You, Lord our God, king of the universe, who bestows good and
who has shown me every kindness."